Abouelmagd Moaz Elsayed, Yousef Obai, Ibrahim Ismail A, Elshahat Ahmed
Faculty of Medicine, Cairo University, Cairo, Egypt.
Faculty of Medicine, Tartous University, Syria.
J Clin Neurosci. 2025 Mar;133:111016. doi: 10.1016/j.jocn.2024.111016. Epub 2024 Dec 28.
Parkinson's disease (PD) is a debilitating neurodegenerative disorder characterized by movement impairments. Vagus nerve stimulation (VNS) is a non-invasive brain stimulation technique that has shown promise in treating various neurological conditions, including PD. This systematic review aimed to evaluate the existing evidence on the efficacy of nVNS in managing PD symptoms.
A comprehensive literature search was conducted to identify relevant studies published up to July 2024. The included studies investigated the effect of nVNS on various PD motor symptoms. The quality of studies was assessed using the Cochrane Risk of Bias 2 (ROB-2) and NIH tool for RCTs, single-arm studies, and case series studies respectively. Statistical analysis was conducted using Review Manager version 5.4.1 with outcomes expressed as Mean differences (MD) with 95% confidence intervals (CI).
The systematic review included eight randomized controlled trials (RCTs), one single-arm study, and one case series, encompassing a total of 217 patients with PD. The review revealed that nVNS in increasing Freezing of Gait (FOG) in PD (p = 0.04). However, no significant differences were found in UPDRS-III (p = 0.19 and p = 0.89 for on and off-medication conditions, respectively), UPDRS-II (p = 0.9), UPDRS-I (p = 0.46), Time Up and Go (p = 0.61), stand time (p = 0.87), walking speed (p = 0.22), or step length measured in meters (p = 0.8). Interestingly, a significant improvement was observed in step length measured in centimetres (p = 0.0005). No study reported serious adverse effects associated with nVNS treatment.
Our finding suggests a potential benefit of nVNS in reducing FOG in PD, but did not demonstrate a significant improvement in other motor symptoms. Larger, longer follow-up studies are needed to confirm the effect nVNS on PD management. PROSPERO number: CRD42024574822.
帕金森病（PD）是一种使人衰弱的神经退行性疾病，其特征为运动障碍。迷走神经刺激（VNS）是一种非侵入性脑刺激技术，已显示出在治疗包括PD在内的各种神经系统疾病方面的前景。本系统评价旨在评估关于非侵入性迷走神经刺激（nVNS）治疗PD症状疗效的现有证据。
进行了全面的文献检索，以识别截至2024年7月发表的相关研究。纳入的研究调查了nVNS对各种PD运动症状的影响。分别使用Cochrane偏倚风险2（ROB-2）和美国国立卫生研究院（NIH）针对随机对照试验、单臂研究和病例系列研究的工具评估研究质量。使用Review Manager 5.4.1进行统计分析，结果以平均差（MD）和95%置信区间（CI）表示。
该系统评价纳入了8项随机对照试验（RCT）、1项单臂研究和1项病例系列，共涉及217例PD患者。评价显示，nVNS可增加PD患者的步态冻结（FOG）（p = 0.04）。然而，在帕金森病统一评分量表第三部分（UPDRS-III）（分别在服药和未服药状态下p = 0.19和p = 0.89）、UPDRS第二部分（p = 0.9）、UPDRS第一部分（p = 0.46）、起立行走试验（p = 0.61）、站立时间（p = 0.87）、步行速度（p = 0.22）或以米为单位测量的步长（p = 0.8）方面未发现显著差异。有趣的是，以厘米为单位测量的步长有显著改善（p = 0.0005）。没有研究报告与nVNS治疗相关的严重不良反应。
我们的研究结果表明nVNS在减轻PD患者的FOG方面有潜在益处，但未显示出其他运动症状有显著改善。需要进行更大规模、更长随访期的研究来证实nVNS对PD治疗的效果。国际前瞻性系统评价注册编号：CRD42024574822。
